subverted, and all modest restraint and decency are abandoned. The want of moral control, indeed, is one of the most common symptoms and indications of insanity; and the actions and expressions of a large number of patients, suffering, at certain periods, under maniacal excitement, are of such a nature that it becomes an imperative duty to protect and shield them from observation as much as possible. The privacy indispensable in cases of this sort can only be properly afforded in houses adapted for the purpose of receiving lunatics, who there, at least, are secluded from the observation of all persons except those under whose care they are immediately placed, and are generally exempted from that mechanical restraint or coercion of the person, which, if they were confined at their own homes, must frequently be inevitable.

There are cases, also, where the presence and example of the patient, if at home, would probably lead to the most distressing and dangerous consequences amongst other members of the family-more especially amongst those of a sensitive and nervous temperament. These remarks respecting private patients apply (as, indeed, is obvious) not merely to those who are dangerous to themselves or others, but to all insane persons whatsoever, of every class and character, including many who, so far as their acts are concerned, might be denominated harmless.

Persons of unsound mind, therefore, whether dangerous or not, are placed in lunatic establishments; some remain there after they are apparently much relieved, because their disease is of a recurrent nature. Others remain there, who, although labouring under insane delusions, are apparently harmless, and generally well conducted, so long as they are under proper control and supervision, but who exhibit their former insane propensities and infirmities the moment that this control and supervision are withdrawn. There are numerous cases, within our recollection, where patients thus circumstanced have been taken out of lunatic establishments upon trial, but who, after a short intercourse with the world, have again exhibited maniacal excitement, or mental incapacity, and have, for the sake of their own safety and welfare, been re-admitted.

We have felt it our duty to submit the foregoing observations to your lordship, for the purpose of putting you in possession of our views and opinions, as set forth in this letter, and of explaining to your lordship the course which we have hitherto pursued, and which we feel bound to continue to pursue, in the exercise of the delicate and responsible functions entrusted to us by the Legislature.

On behalf of the Commissioners in Lunacy.

ASHLEY, Chairman.

R. W. S. LUTWIDGE, Secretary.

Psychological Fragments.

PROGRESSIVE GENERAL PALSY.-In the Annales Medico-Psychologiques, M. Lunier has published a paper on progressive general palsy, which he seeks to show may affect the sound in mind, as well as the insane. He says its nature was misunderstood until towards the close of the last century; it was described by Haslam, Esquirol, and Georget, as a complication or rather a termination of insanity. Progressive general palsy was for a long while, and is even now, regarded by many practitioners as a disease proper to the insane. Nevertheless, one of the earliest works published on this

subject, the thesis of M. Delaye, which appeared in 1824, contains a case of progressive general palsy, which occurred in an individual whose intel lect was perfectly sound. The author of this excellent dissertation, however, considers the case in question to be exceptional, and the greater number of practitioners who have since written on the subject, speak of it as the only case that has come to their knowledge. The name of general palsy of the insane, which is used to designate the disease, serves to propagate and maintain the error. A few more cases, he observes, have since been published, illustrative of the view he takes, and he adds that, if we read attentively the facts brought forward by J. Bayle, Delaye, Calmeil, Foville, Deveau, Lelut, Parchappe, Wachter, Requin, &c., and the excellent description many of these authors have given of general palsy, it will be easy to recognise that this morbid state, which they have described as a symp tom or termination of insanity, existed in many of their cases before there was any lesion of the intellectual faculties, and that the lesion occurred most frequently consecutively only, and as a complication of the paralysis. M. Lunier seeks to establish that progressive general palsy may be met with in the general hospitals, although not so frequently as in lunatic asyla; that the palsy, in the one case, in no respect differs from that in the other; that the lesions of the intellectual faculties met with in such cases do not deserve generally the name of insanity, but consist simply in a diminution, or an abolition, or a more or less complete palsy of these faculties, comparable to the palsy of motion and sensation, and finally that progressive general palsy constitutes a special and clearly defined disease, which ought to be completely separated from insanity, just as are epilepsy and hysteria.

His essay is divided into three parts; the first treats of those cases in which the progressive general palsy has not been preceded nor accompanied by insanity or dementia; the second describes those cases where the palsy, without having been preceded by lesions of the intellectual faculties, has been afterwards complicated with dementia; and in the third will be brought forward those cases in which the general palsy has been or seems to have been preceded by mania or monomania, transformed or not afterwards into dementia.

Progressive general palsy rarely reaches its second stage, or even the termination of its first, without the occurrence of symptoms of dementia. It is only at the commencement of the disease that there is not found any lesion of the intellectual faculties. These cases are more frequently met with in private practice. The absence of all lesion of the intellect at the commencement of general palsy renders the diagnosis of the disease difficult. The symptoms of dementia are generally those first recognised by the relatives or friends of the patient, and when a medical man is called in, he is astonished to find the palsy already much advanced, and most frequently completely incurable.

The first part contains the details of six cases; in the first, that of a man named Lenoir, fifty-six years of age, the disease was hereditary, and the patient himself was subject to attacks of cerebral congestion, for which he had been in the habit of losing blood-a practice he had latterly neglected; besides which, he had had a rather free hemorrhoidal flux, which had ceased of late. Lenoir presented almost all the symptoms of the first stage of progressive general palsy; weakness of the special sensations and of the general sensibility, hesitation in walking, diminution of the strength of the upper limbs, a slight embarrassment in speaking, loss of the generative power, fleeting attacks of giddiness; there was not, however, any affection of the intellectual faculties. The treatment consisted in the abstraction of blood,

the administration of purgatives, low diet, and rest. Some of the symptoms of congestion were thus relieved, but the palsy continued to make progress slowly. In the second case, the hereditary character of the disease was also shown, and more and more frequent and violent attacks of cerebral congestion were induced by the suppression of an epistaxis. The disease in this case was only commencing. The third case was that of a Pole, forty-three years of age, much addicted to drinking and to venery. The disease was also hereditary in this case. Eight years prior to coming under notice, he had had an attack of apoplexy, followed by hemiplegia, respecting which M. Lunier observes, it is not uncommon to see progressive general palsy follow hemiplegia, the result of one or more attacks of cerebral congestion. In such cases the hemiplegia progressively disappears, but at the end of a certain time, if the patient be carefully examined, it will be found that the palsy is not so clearly defined; there are irregularities, and one of the limbs of the other side presents slight symptoms of palsy, or perhaps the sensibility is greater in the arm of one side and the leg of the other, or the patient sees better with one eye, and hears better with the opposite ear. These singular anomalies form the transition, so to say, of the hemiplegia into general palsy. When the paralysis begins to become general, the hemiplegia becomes stationary: this is one of the signs which should make us dread the occurrence of general palsy in the hemiplegiac; when the general palsy is fully established, the hemiplegia, instead of progressing towards a cure, increases in intensity, and follows the progress of the general disease. In those persons in whom general palsy has thus succeeded hemiplegia, there is always, even in the third stage of the disease, a predominance of the palsy in the side primitively affected. The patient in the fourth instance was a young man, eighteen years of age, in whom the disease supervened in consequence of a fall from a height of several feet, on the left side of the head, by which concussion of the brain was caused. In this case, M. Lunier considers the immediate cause of the general palsy to have been acute hydrocephalus become chronic. M. Requin has published a case of progressive general palsy following an injury to the head, which ultimately terminated fatally. The autopsy disclosed evidences of chronic meningitis. The fifth case is one previously published by M. Brierre de Boismont; and the sixth is that recorded by M. Delaye, already alluded to.

The second series of cases, in which are recorded those in which the progressive general palsy was not preceded by insanity, but was afterwards accompanied by dementia, are four in number. The complication or occurrence of dementia, M. Lunier regards as an almost constant symptom of the disease, when it has reached a certain stage, and he believes it to depend on the same organic cause as the lesions of motion and sensation. The first case is that of a woman, fifty years of age, in whom again the disease was hereditary. The disease advanced to the second stage, was accompanied by symptoms of dementia, and then became stationary. The second case is an instance of a predisposition to cerebral congestion, with intermittent and alternative palsy of the arms consequent on hard labour and general progressive palsy. The patient was affected with suicidal lypemania. The man was thirty-five years old. The third is an instance of general palsy in the commencement of the second stage. The disease was hereditary. The abuse of mercury was considered to have had something to do in causing the disease; but this M. Lunier will not admit, and seems more inclined to refer it to the abuse of tobacco. He says that great smokers are peculiarly predisposed to cerebral congestion, and consequently to general paralysis. The question he thinks worthy of further examination.

In the second stage of general paralysis, and sometimes even in the third, the vegetative functions are generally well performed. The appetite is good, often even rather voracious, and the patients present some embonpoint. Emaciation, marasmus, and gangrenous spots occur later in the disease. M. Baillarger was the first to point out the loss of the generative power in the commencement of the disease. M. Lunier observes that he has noticed it in several cases. It is a premonitory symptom of some importance, but in some cases there occurs a kind of venereal orgasm, which may be present, although rarely, even in the third stage of the disease.

The loss of the memory is undoubtedly the beginning of dementia. It is often the only sign of intellectual debility that can be discovered during the first and even the second stage of general palsy.

The fourth and last case in this series is one in which the disease was hereditary, and was attended by two attacks of ambitious delirium. It was ultimately complicated with dementia.

The third series in which the general paralysis was, or seemed to be, preceded by mania or monomania, transformed or not afterwards into dementia, consists of one case only. The patient, a man fifty years of age, had a fall from a height of eight or ten feet on the back part of his head, a few days after which he was admitted into the Bicêtre with symptoms of mania. M. Lunier is of opinion that at this time the patient was labouring under unrecognised general paralysis. At the date of the report, ten years after the accident, the man did not present any signs of dementia.

HALLUCINATIONS IN EARLY INFANCY.-Dr. Thore, jun., in a communication published in the Annales Medico-Psychologiques, details the case of an infant, fourteen months and a half old, who had been poisoned by the seeds of the datura stramonium. In this case, hallucinations of the organs of sight were well marked, as evidenced by the motions of the child. She appeared to be incessantly seeking for imaginary objects in front of her: she stretched out her hands to get at them, and clung to the sides of her cradle to reach them the better. While these hallucinations were the most marked, actual vision appeared to be abolished, thus affording an additional proof that the integrity of an organ, which becomes hallucinate, is not necessary in order that the false sensation may occur.

M. Thore observes, that those medical men who have especially devoted themselves to the consideration of insanity, have not hitherto studied much the hallucinations which occur during the early periods of life. Examples after seven years of age are met with in their writings, but they are few in number. Nevertheless, they are frequently noticed even before the age just mentioned, and are developed under the influence of greatly differing causes. It is not uncommon to notice them in the course of acute diseases. M. Thore has frequently met with hallucinations of the sight and hearing in children of from four to five years of age. He adds, that they are of occasional occurrence in children, even while in perfect health. They then appear to form part of a previous dream.

PROLONGED BATHING AND CONTINUous Irrigation IN THE TREATMENT OF THE ACUTE FORMS OF INSANITY.-M. Brierre de Boismont advances the following propositions as among the results of this practice :

1st. The greater slowness of the circulation and respiration-the introduction of a large quantity of water into the economy-the general and gradual refrigeration, show that these baths have an essentially calming and sedative action.

2nd. The period of convalescence ought to be carefully watched, because

relapses are not rare, when the patients are too suddenly exposed to the influence of the causes which have occasioned the disease.

3rd. When acute mania is complicated with acute delirium, and the patient refuses drinks, the treatment is inefficacious.

4th. Prolonged bathing and continuous irrigations appear to M. Brierre de Boismont to be useful in hysterical affections, and many other nervous diseases with excitement.

5th. Prolonged bathing is without its disadvantages; the fatigue it causes soon disappears; it does not deprive the system of any important principle, nor leave behind it that utter debility so often caused by free bleedings, and which has more than once terminated in dementia.

M. Brierre de Boismont's treatment by the plan above indicated appears to have been very successful.-Gazette Médicale.

ENDEMIC CEREBRO-SPINAL MENINGITIS.-M. Corbin, of Orleans, has published in the Gazette Médicale an account of an endemic cerebro-spinal meningitis, which affected the garrison of that city in 1847-48. The following are his conclusions:

1st. In the disease called cerebro-spinal meningitis, which has raged epidemically for ten years, especially in certain garrisons, the inflammation sometimes extends to the nervous centres, principally to the spinal marrow, which becomes softened. It is a cerebro-spinitis, or more correctly, a meningo-myelitis, a meningo-encephalitis.

2nd. The disease prevails principally during the winter, and appears to depend chiefly on the overcrowding (encombrement), the alteration of the atmosphere, perhaps from a too high artificial temperature: whence there results, as a means of prevention, the necessity of inverse hygienic conditions.

3rd. The treatment ought to be antiphlogistic and revulsive.

4th. Special circumstances, which have been called the epidemic character, may require a special medication. Opium was very useful in the treatment of the disease during the latter part of the time that the epidemic prevailed in Avignon.

EXPERIMENTS ON THE RESPIRATORY AND ARTERIAL MOTIONS OF THE BRAIN.-M. Flourens had hitherto in his experiments only recognised the respiratory motion of the brain; he denied the arterial. Additional researches have since convinced him that, as Haller had already indicated, there exist, in fact, two motions of the brain:

1st. The respiratory, which all anatomists attribute to the alternating flux and reflux of the venous blood. But while Haller and Lamure profess that these flux and reflux are effected by the jugular veins, M. Flourens believes that the principal source of the venous blood, which by its reflux causes the swelling of the brain, is to be found in the two great vertebral venous sinuses.

2nd. And the arterial, which, according to M. Flourens' experiments, depends on the influx of the arterial blood, which is sent to the brain on each contraction of the left ventricle of the heart.-Gazette Médicale.

HYSTERIA. At a meeting of the Société Medico-Pratique of Paris, M. Michea detailed a case of hysteria, as follows:

The patient, twenty-five years of age, of a robust constitution, and apparently sanguine temperament, had a first attack of hysteria during her first pregnancy. When summoned to see her, the attacks having become very frequent, M. Michea ascertained that there existed insensibility of the skin and mucous membranes, without palsy of motion. The urine of the patient